|Year : 2015 | Volume
| Issue : 2 | Page : 109-111
Occult male breast cancer with axillary metastasis: A rare case report
Komal Sawaimul, Banyameen Mohamad Iqbal, Tushar Kambale
Department of Pathology, Dr. D.Y. Patil Medical College and Research Center, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||14-May-2015|
Banyameen Mohamad Iqbal
Department of Pathology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Breast cancer is very rare in men. It accounts for 0.2% of all cancers and 1% of all breast cancers. The occurrence of occult breast cancer that present as axillary metastasis as the first manifestation is even rarer in men. We are hereby presenting an extremely rare case of a septuagenarian male patient who presented with occult breast cancer and axillary lymph node metastasis.
Keywords: Breast cancer, lymph node metastasis, occult malignancies
|How to cite this article:|
Sawaimul K, Iqbal BM, Kambale T. Occult male breast cancer with axillary metastasis: A rare case report. J Sci Soc 2015;42:109-11
| Introduction|| |
Male breast cancer is rare. It accounts for 0.2% of all cancers, and 1% of all breast cancers, , and the occurrence of occult breast cancer is even rarer in men.  The peak age of incidence for males is 71 years while for females it is 52 years.  Occult male breast cancer with axillary metastasis is an extremely rare malignant neoplasm that has a high incidence of misdiagnosis. Due to the atypical location, a correct diagnosis is often reached during the later stages of cancer. In addition, most patients present late for several reasons, including the absence of early signs and symptoms, and reduced awareness of the existence of such pathology among patients.
| Case report|| |
A 70-year-old male patient presented with a painless and enlarged lymph node in the right axilla for about 6 months with mild tenderness in his right breast and occasional mild to minimal mucoid nipple discharge without any palpable breast mass. His history showed no evidence of liver diseases; no medication taken and no history of any hormonal treatment. Patient has a significant family history of malignant breast disease in the family. Fine needle aspiration cytology of the axillary lymph node showed that it was invaded by infiltrating ductal carcinoma (IDC) which was suspected to be metastasized from breast [Figure 1] and [Figure 2]. The patient was kept in hospital for further workup and a series of investigations were performed like mammography, ultrasonography, computed tomographic scan, magnetic resonance imaging etc., to find out the primary malignancy but all these investigations were within normal limits and no primary focus in breast or any other organ was found. The case was provisionally diagnosed as metastatic deposits from occult IDC and the modified radical mastectomy with axillary lymph node dissection was done. The histological examination of paraffin sections stained with hematoxylin and eosin revealed that no tumor focus was found in breast, but 2 out of 11 axillary lymph nodes were invaded by IDC.
|Figure 1: Photomicrograph showing metastatic deposits of a typical ductal epithelial cells (Leishman ×40)|
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|Figure 2: Photomicrograph showing high power view of metastatic deposits of infi ltrating ductal carcinoma|
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| Discussion|| |
Breast cancer is 100 times more common in women than in men. It accounts for <1% of male cancers. It usually occurs in men of advanced age and is often detected at a more advanced state. ,,, Ectopic breast tissue has been identified in a number of regions, including in the vulva, anal polyps, axilla  and axillary lymph nodes  more frequently in females and the axillary region. Recent epidemiologic data suggested that the incidence of male breast cancer has been steadily increasing.  The epidemiologic risk factors may include prostate cancer and its endocrine therapy, gynecomastia, occupational exposures (e.g., electromagnetic fields, polycyclic aromatic hydrocarbons, and high temperatures), dietary factors (e.g., increased meat intake, less consumption of fruits and vegetables), and alcohol intake. Recently, the genetic factors got more attention by scientists.  The mutations of BRCA1, BRCA2 and MMR gene may play very important roles in the onset of the male breast cancer; and other genetic factors involved could include AR gene, CHEK2 gene, cytochrome P45017 (CYP17), the XXY karyotype (Klinefelter syndrome), and the PTEN tumor suppressor gene associated with Cowden syndrome, and so on. The BRCA1 and BRCA2 germ-line mutation is known associated with the hereditary breast cancer  and the MMR germ-line mutation (especially hMLH1) for the hereditary nonpolyposis colorectal carcinoma (HNPCC). Some researchers regarded the breast cancer, especially the male breast cancer, as a part of the tumor spectrum of HNPCC, and thought the breast cancer might be an extracolonic manifestation of HNPCC. 
Occult breast cancer is even rarer in men. It usually presents as lymph node metastasis of axilla, supraclavicular fossa and infraclavicular fossa as the first manifestation.  In our case, the patient presented with axillary lymph node metastasis as the first manifestation. The most common causes of axillary malignant lymph nodes include lymphoma and metastasis from breast cancer, lung cancer, melanoma, and squamous cell cancer. Research shows that in approximately 50% of cases with occult breast cancer the cancer focus cannot be found in the breast specimen.  In our case, no tumor focus was found in breast specimen.
The final diagnosis was made after many pathologists' consultation and series of examinations.
The currently recommended treatment is the modified radical mastectomy with axillary lymph node dissection. It was reported that male breast carcinomas have a higher positive rate of hormone receptor than the female breast carcinomas, and so the adjuvant hormonal therapy is theoretically very promising.  However, the family of the patient did not agree to undergo any sort of hormonal and chemotherapy considering the age of the patient and eventually the patient was discharged and is on regular follow-up for the last 6 months that is uneventful so far.
| Conclusion|| |
Occult male breast cancer, though very rare, does exist. Efforts to increase awareness among patients and physicians will lead to earlier presentation, and therefore diagnosis before spreading to other organs. Like the majority of cancers, male breast cancer can be cured or controlled if diagnosed and treated properly at its early stages.
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[Figure 1], [Figure 2]